Intravitreal Anti-Vascular Endothelial Growth Factor Therapy for Retinal Angiomatous Proliferation: A Review of the Literature and Therapeutic Considerations

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Retinal angiomatous proliferation (RAP) is a subtype of neovascular age-related macular degeneration (AMD). In the past, this peculiar type of neovascularization was considered to be refractory to treatment, and the efficacy of anti-vascular endothelial growth factor (VEGF) therapy in RAP was not thoroughly evaluated in the early clinical trials. However, more recent studies focusing on treatment outcomes in RAP have shown that visual acuity can be improved or at least maintained in the majority of eyes using anti-VEGF therapy. Favorable results were achieved regardless of the regimens used which included fixed-dosing, as-needed, and treat-and-extend regimens. Nowadays, anti-VEGF therapy is a widely used first-line therapy for RAP. RAP shows several characteristics that distinguish it from other subtypes of neovascular AMD. The choroid is usually very thin and the incidence of geographic atrophy or retinal pigment epithelial tear is relatively high in RAP compared to the other subtypes. It is helpful for clinicians to consider these characteristics, which may influence the treatment outcome. In this article, the results of previous studies on anti-VEGF therapy for RAP are reviewed and important therapeutic considerations are discussed.